Tarsal tunnel syndrome

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What is Tarsal Tunnel Syndrome?

Tarsal Tunnel Syndrome is a condition caused by compression or entrapment of the posterior tibial nerve as it passes through the tarsal tunnel, a narrow space on the inside of the ankle. This tunnel is formed by bone and the flexor retinaculum, a thick band of tissue. The condition is similar to carpal tunnel syndrome in the wrist but affects the foot and ankle.

Mechanism of Injury:

Tarsal Tunnel Syndrome is usually caused by compression of the posterior tibial nerve due to factors such as:

Overuse or Repetitive Strain: Activities that put excessive pressure on the feet, such as prolonged standing, walking, or running, especially on hard surfaces.
Foot and Ankle Injuries: Sprains, fractures, or other injuries that cause swelling or structural changes in the ankle, leading to nerve compression.
Flat Feet or Fallen Arches: These conditions can stretch the tibial nerve and compress it within the tarsal tunnel.
Abnormal Foot Mechanics: Poor foot biomechanics, such as overpronation (inward rolling of the foot), can contribute to nerve compression.
Systemic Conditions: Conditions like diabetes, arthritis, or vascular problems that cause swelling or inflammation can also lead to tarsal tunnel syndrome.
Growths: Tumors, cysts, or varicose veins within the tarsal tunnel can compress the nerve.

Symptoms

Burning or Tingling Pain: A burning or tingling sensation, often described as "pins and needles," on the inside of the ankle, the sole of the foot, and sometimes extending into the toes.
Numbness: Numbness in the foot, particularly along the sole, which may worsen after standing, walking, or physical activity.
Shooting Pain: Sharp, shooting pain that may radiate from the ankle into the foot, particularly when walking or standing for long periods.
Swelling: In some cases, swelling around the ankle may accompany the pain and discomfort.
Foot Weakness: Weakness in the muscles of the foot, making it difficult to flex the toes or maintain balance.
Worsening Pain at Night: Symptoms often intensify at night or after prolonged periods of rest.

Treatment

Rest: Avoid activities that aggravate the condition, particularly those that involve prolonged standing or walking.
NSAIDs: Over-the-counter anti-inflammatory medications like ibuprofen can help manage pain and reduce inflammation.
Physical Therapy: Exercises to strengthen the muscles of the foot and ankle, improve flexibility, and correct abnormal foot mechanics. Nerve gliding exercises may also be introduced to help mobilise the tibial nerve.
Orthotics: Custom orthotic inserts or supportive shoes can help correct foot mechanics and reduce pressure on the tibial nerve.
Immobilisation: In some cases, a brace or splint may be recommended to immobilise the ankle and allow the nerve to heal.
Corticosteroid Injections: Injections around the tarsal tunnel may reduce inflammation and relieve pain, providing temporary relief.
Massage: Focused on relieving tension in the muscles around the ankle and foot, improving circulation, and reducing nerve compression.
Dry Needling: May be used to target tight muscles and tissues around the tarsal tunnel, helping to alleviate pressure on the nerve.
Ultrasound Therapy: Applied to the area to reduce inflammation, improve blood flow, and promote healing of the nerve.
Cupping: Utilised to increase blood flow, reduce muscle tightness, and decrease pressure on the nerve.
Rehabilitation Plan: A tailored program that includes strengthening exercises, stretching, and gradual return to activity, focusing on preventing recurrence.
Surgical Intervention: In severe cases where conservative treatments fail, surgery may be necessary to release the tarsal tunnel and decompress the nerve.